Anal warts can be treated with agents such as topical Fluorouracil (Efudex) and Imiquimod (Aldara), but they have a low cure rate. Trichloroacetic acid (TCA) and cryotherapy with liquid nitrogen are more successful but may require several treatments, especially with large lesions. Radiofrequency and laser therapy produce 90 percent cure rates and is the preferred treatment method by Dr.Shu.
Treatment for an acute fissure is quite simple when it is identified within a month of onset. 85% to 90% patients respond well to anal care measures. Once a fissure has become chronic,, it is more difficult to treat. Topical solutions such as nifedipine gel or nitroglycerin ointment have about 50 percent success rates. Most patients couldn’t tolerate the headache side effect from nitroglycerin ointment. Chronic fissures are usually treated with lateral sphincterectomy, a surgical office procedure that cures 90-95% of cases. A chemical sphincterectomy using a botox injection into the anal sphincter is an alternative option.
Anal fistulas are usually caused by an abscess in the anal area due to infection. Patients often experience recurrent infection with intermittent drainage of pus from the anal’s opening. Abscess formation can be easily treated using incision and drainage (I&D), antibiotics, and frequent Sitz baths.
Patients with chronic complicated fistulas are treated with a fistulotomy or fistulectomy, including cutting setons, advancement flaps or muscle repair and fibrin glue injection.
Abscesses also begin as an infection in the anal glands. The patients usually have severe rectal pain with local redness and swelling. Superficial perianal abscesses are easily drained in the office under local anesthesia, it resolve after treated with antibiotics and anal care measures.
The infection may track through the sphincter muscles to enter the surrounding space or above levator muscle. The patients usually have toxic signs and fever. and these abscesses are difficult to diagnose and require a high index of suspicion.
External hemorrhoids are those occur outside the anal verge. External hemorrhoids usually affect the cleansing after the bowel movement and cause the skin irritation and itching. The thrombosed external hemorrhoids are sometimes very painful if the varicose veins rupture and the blood clots develop, it is often accompanied by swelling and irritation. These hemorrhoids are typically treated with either incision and removal of the clot or with external hemorrhoidectomy. Simply draining the clot can lead to recurrence, so it is generally recommended to completely excise the thrombosed hemorrhoids.
Internal hemorrhoids are graded from I to IV based on the degree of prolapse. Grade I hemorrhoids have no prolapse. Grade II lesions bulge with defecation but then recede spontaneously. Grade III hemorrhoids require digital replacement after prolapsing, while grade IV hemorrhoids cannot be replaced once prolapsed.
Anal tags usually arise from previous external hemorrhoids and may periodically cause itching, anxiety or hygienic problems. The tags can be surgically removed using local anesthesia.
Anal cancer is account for 2% of cancer in the gastrointestinal tract. Anal or rectal cancer generally do not produce any pain; an external or internal mass may be palpable. Some lesions are so soft that they are missed on palpation. Anal cancers are staged and treated differently from rectal cancers. Anal cancer can take several forms including ulcers, polyps or verrucous growths; treatment is typically a combination of surgery, chemotherapy and pelvic radiation.